@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/sct/> .

# - resource -------------------------------------------------------------------

[] a fhir:PlanDefinition;
  fhir:Resource.id [ fhir:value "opioidcds-02"], [ fhir:value "effective-data-requirements"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition";
       fhir:index 0
     ], [
       fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition";
       fhir:index 1
     ]
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.value [ fhir:value "shareable" ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.value [ fhir:value "computable" ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.value [ fhir:value "executable" ]
  ], [
     fhir:index 3;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.value [ fhir:value "publishable" ]
  ], [
     fhir:index 4;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n  ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n    where Routines.\"Is Subacute or Chronic Pain Prescription?\"( AmbulatoryOpioidPrescription )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "0" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 5;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\":\n  exists( \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "1" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 6;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Age Less than 18 Years Is Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// CDC 2022 General Inclusion Criteria\ndefine \"Age Less than 18 Years Is Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "2" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 7;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Patient Age Less Than 18" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Patient Age Less Than 18\":\n  if (Config.\"Age Less than 18 Years Is Enabled\") then\n    AgeInYearsAt(Today()) < 18\n  else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "3" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 8;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Sickle Cell Check Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// Sickle Cell\ndefine \"Sickle Cell Check Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "4" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 9;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Sickle Cell Assumed Active" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Sickle Cell Assumed Active\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "5" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 10;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "US Core-Categorized Conditions" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// 3. Medications indicating end of life\n    /* or exists (\n      \"Medications Indicating End of Life\"\n    ) */\n\ndefine \"US Core-Categorized Conditions\":\n  [Condition: category in \"Encounter Diagnosis Condition Category\"]\n    union [Condition: category in \"Problem List Condition Category\"]\n    union [Condition: category in \"US Core Health Concern Condition Category\"]" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "6" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 11;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Positive Sickle Cell Condition" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Positive Sickle Cell Condition\":\n  if Config.\"Sickle Cell Check Enabled\" and not Config.\"Sickle Cell Assumed Active\"\n    then (\n      \"US Core-Categorized Conditions\" C\n        where C.code in \"Sickle Cell Diseases\"\n          and C.clinicalStatus in \"Active Condition\"\n    ) else if Config.\"Sickle Cell Check Enabled\" and Config.\"Sickle Cell Assumed Active\"\n        then (\n          \"US Core-Categorized Conditions\" C\n            where C.code in \"Sickle Cell Diseases\"\n        )\n      else null" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "7" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 12;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Condition Positive for Sickle Cell" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Condition Positive for Sickle Cell\":\n  if (Config.\"Sickle Cell Check Enabled\") then\n    exists(\n      Common.\"Positive Sickle Cell Condition\"\n    ) \n  else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "8" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 13;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Active Cancer Treatment Encounters Condition Is Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// Active Cancer Treatment\ndefine \"Active Cancer Treatment Encounters Condition Is Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "9" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 14;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Encounter Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// End of Opioid Naive Routine\n\n/*\n**  Routine #3\n**  Active Cancer Treatment Routine\n**\n**  Definition                    | Answer to Proceed   | Details                                    | Data (Terminology) Requirement\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Two office visits within the  | No                  | Look for a minimum of two distinct         | Office Visit\n**  past 12 months                |                     | encounters within 12 months of the date    |\n**                                |                     | of the current visit for which each of the |\n**                                |                     | following is true:                         |\n**                                |                     |   - the encounter diagnosis (primary or    |\n**                                |                     |     secondary or co-morbidity diagnosis)   |\n**                                |                     |     is listed in the CDC Malignant Cancer  |\n**                                |                     |     Conditions value set                   |\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Office visits with an         | No                  | The encounter is performed by an           | Oncology specialty\n**  oncology specialist           |                     | oncologist as defined in the oncology      | designations (NUCC)\n**  present                       |                     | specialty designations using the           |\n**                                |                     | National Uniform Claim Committee           |\n**                                |                     | (NUCC) classifications                     |\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Office visits including CDC   | No                  | The encounter diagnosis (primary or        | CDC malignant cancer\n**  malignant cancer              |                     | secondary or co-morbidity diagnosis)       | conditions\n**  condition                     |                     | is listed in the CDC Malignant Cancer      |\n**                                |                     | Conditions value set                       |\n**  ----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine \"Encounter Period\":\n  Interval[Today() - 12 months, Today())" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "10" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 15;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "USCore Encounter Cancer Diagnoses" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"USCore Encounter Cancer Diagnoses\":\n  [Condition: category in \"Encounter Diagnosis Condition Category\"] CancerDiagnoses\n    where CancerDiagnoses.code in \"CDC malignant cancer conditions\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "11" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 16;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Encounters with Cancer Diagnosis During Encounter Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// encounter-diagnosis, problem-list and health-concern Conditions\n// define \"US Core-Categorized Cancer Diagnoses\":\n//   Common.\"US Core-Categorized Conditions\" C\n//     where C.code in Common.\"CDC malignant cancer conditions\"\n\n// define \"Encounters with Cancer Diagnosis During Encounter Period\":\n//   [Encounter] Encounter\n//     with \"US Core-Categorized Cancer Diagnoses\" CancerDiagnosis\n//     such that date from Encounter.period.\"start\".value in day of \"Encounter Period\"\n//       and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)\n\ndefine \"Encounters with Cancer Diagnosis During Encounter Period\":\n  [Encounter] Encounters\n    where date from Encounters.period.\"start\" in day of \"Encounter Period\"\n      and exists (\n        Common.\"USCore Encounter Cancer Diagnoses\" CancerDiagnoses\n          where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)\n      )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "12" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 17;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Number of Encounters with Cancer Diagnosis During Encounter Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Number of Encounters with Cancer Diagnosis During Encounter Period\":\n  Count (\"Encounters with Cancer Diagnosis During Encounter Period\")" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "13" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 18;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\":\n  \"Number of Encounters with Cancer Diagnosis During Encounter Period\" >= 2" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "14" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 19;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "USCore Problem List Cancer Diagnoses" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"USCore Problem List Cancer Diagnoses\":\n  [Condition: category in \"Problem List Condition Category\"] CancerDiagnoses\n    where CancerDiagnoses.code in \"CDC malignant cancer conditions\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "15" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 20;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Has Active Cancer Diagnosis on Problem List" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Has Active Cancer Diagnosis on Problem List\":\n  exists (\n    Common.\"USCore Problem List Cancer Diagnoses\" CancerDiagnoses\n      where CancerDiagnoses.category in Common.\"Problem List Condition Category\"\n        and exists(\n          CancerDiagnoses.clinicalStatus.coding ClinicalStatus\n            where ClinicalStatus.code ~ 'active'\n        )\n  )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "16" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 21;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Active Cancer Treatment?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Is Active Cancer Treatment?\":\n  if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") \n    then \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n      or \"Has Active Cancer Diagnosis on Problem List\"\n  else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "17" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 22;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "End-Stage Disease Criteria Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// CDC 2022 General Inclusion Criteria\ndefine \"End-Stage Disease Criteria Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "18" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 23;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Conditions Likely Terminal for Opioid Prescribing" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Conditions Likely Terminal for Opioid Prescribing\":\n  if (Config.\"End-Stage Disease Criteria Enabled\") then\n    exists (\n      Common.\"US Core-Categorized Conditions\" EOLC\n        where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n          // and EOLC.clinicalStatus in Common.\"Active Condition\"\n    )\n  else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "19" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 24;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "CDC 2022 Guideline General Inclusion Criteria" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"CDC 2022 Guideline General Inclusion Criteria\":\n  not \"Patient Age Less Than 18\"\n    and not \"Condition Positive for Sickle Cell\"\n    and not \"Is Active Cancer Treatment?\"\n    and not \"Conditions Likely Terminal for Opioid Prescribing\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "20" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 25;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Opioid Naive Prescription Condition Is Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// Opioid Naive\ndefine \"Opioid Naive Prescription Condition Is Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "21" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 26;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Can the implementing EHR support queries for past medications by date range?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// Subroutine 2 - Past Medications\ndefine \"Can the implementing EHR support queries for past medications by date range?\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "22" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 27;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Active Ambulatory Opioid Rx" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Active Ambulatory Opioid Rx\":\n    if Config.\"Can the implementing EHR support queries for past medications by date range?\" then\n      (\n        \"Get MedicationRequest Medication as Code\"(\"Get Active Ambulatory Medication Requests\"([MedicationRequest]))\n      ) Rx\n        where date from Rx.authoredOn 2 years or less on or before Today()\n          and Rx.medication in \"Opioid analgesics with ambulatory misuse potential\"\n    else\n        List<FHIR.MedicationRequest>{}" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "23" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 28;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Prescription/Dispense Inclusion Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// End of CDC 2022 General Inclusion Criteria Routine\n\n/*\n**  Routine #2\n**  Opioid Naive Routine\n**\n**  Definition                    | Answer to Proceed   | Details                                           | Data (Terminology) Requirement\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for an existing prescription (order) for     | Opioid analgesics with\n**  ambulatory misuse potential   |                     | opioid that is in the value set for opioid with   | ambulatory misuse potential\n**  prescription in past 90 days  |                     | ambulatory abuse potential authored               |\n**  excluding the previous 24     |                     | within the past 90 days (excluding previous 24    |\n**  hours                         |                     | hours)                                            |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for evidence of active medication on         | Opioid analgesics with\n**  ambulatory misuse potential   |                     | the medication list that is in the value set      | ambulatory misuse potential\n**  reported in past 90 days      |                     | for opioid with ambulatory care abuse             |\n**  excluding previous 24 hours*  |                     | potential                                         |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for evidence of a dispensing event for       | Opioid analgesics with\n**  ambulatory misuse potential   |                     | medication that is in the value set for opioid    | ambulatory misuse potential\n**  dispensing event in past 90   |                     | with ambulatory use potential occurring           |\n**  days excluding previous 24    |                     | within the past 90 days (excluding previous 24    |\n**  hours                         |                     | hours)                                            |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  *Future consideration: Current algorithm addresses only orders (prescriptions).\n**\n**  Note – orders use RxNorm, but medication lists and dispensed medication will\n**  require an NDC value set and/or local mapping of NDC to RxNorm to enable this element\n**\n*/\n\ndefine \"Prescription/Dispense Inclusion Period\":\n  Interval[Now() - 90 days, Now() - 24 hours]" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "24" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 29;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Opioid RX with Ambulatory Abuse Potential In Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Opioid RX with Ambulatory Abuse Potential In Past 90 Days\":\n  Common.\"Active Ambulatory Opioid Rx\" Rx\n      where Rx.authoredOn during day of \"Prescription/Dispense Inclusion Period\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "25" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 30;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days\":\n    if (Config.\"Opioid Naive Prescription Condition Is Enabled\") then\n      exists (\"Opioid RX with Ambulatory Abuse Potential In Past 90 Days\")\n    else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "26" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 31;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// NOTE: 2020-02-05: Review direction of MedicationStatement resource (US-Core focusing on MedicationRequest i/o Statement)\n// NOTE: 2020-04-21: MedicationStatement a) Shouldn't be use since guidance/direction from USCore is targeting MedicationUse in R5, and b) Breaks in the publisher\n/* define \"Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\":\n    [MedicationStatement: Common.\"Opioid analgesics with ambulatory misuse potential\"] Statement\n        where Statement.status in {'active', 'completed'}\n            and Statement.effective during day of \"Report Inclusion Period\" */\n\n/* define \"Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\":\n    Config.\"Opioid Naive Report Condition Is Enabled\"\n        and exists (\"Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\") */\n\ndefine \"Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\":\n    [MedicationDispense: Common.\"Opioid analgesics with ambulatory misuse potential\"] OpioidDispense\n        where OpioidDispense.whenHandedOver during day of \"Prescription/Dispense Inclusion Period\"\n            and OpioidDispense.status = 'completed'" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "27" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 32;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\":\n  if (Config.\"Opioid Naive Prescription Condition Is Enabled\") then\n    exists (\"Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\")\n  else false" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "28" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 33;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Opioid Naive?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.\ndefine \"Is Opioid Naive?\":\n    not (\"Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days\")\n    /* and not (\"Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\") */\n    and not (\"Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\")" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "29" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 34;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommonConfig" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Opioid Treatment Plan Verification Enabled" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// Recommendation 2\ndefine \"Opioid Treatment Plan Verification Enabled\":\n  true" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "30" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 35;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Treatment Plan Lookback Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Treatment Plan Lookback Period\":\n  Interval[Today() - 90 days, Today()]" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "31" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 36;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Opioid Treatment Plan Creation or Update in Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Opioid Treatment Plan Creation or Update in Past 90 Days\":\n  [CarePlan: category in Common.\"Pain treatment plan\"] PainTreatmentPlan\n    where PainTreatmentPlan.status in { 'active', 'completed' }\n      and (\n        FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of \"Treatment Plan Lookback Period\"\n          or PainTreatmentPlan.meta.lastUpdated during day of \"Treatment Plan Lookback Period\"\n      )\n      and exists(\n        \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\".recorder Recorder\n          where Recorder ~ PainTreatmentPlan.author\n      )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "32" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 37;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Had Opioid Treatment Plan Reviewed in Past 90 Days" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Had Opioid Treatment Plan Reviewed in Past 90 Days\":\n  exists (\n    [Procedure: Common.\"Pain management procedure\"] PainManagementProcedure\n      where PainManagementProcedure.performed during day of \"Treatment Plan Lookback Period\"\n        and exists (\n          PainManagementProcedure.performer Performer\n            with \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" ChronicPainScript\n            such that Performer.actor ~ ChronicPainScript.recorder\n        )\n  )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "33" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 38;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?\":\n  Config.\"Opioid Treatment Plan Verification Enabled\"\n    and not (\n      exists ( \"Opioid Treatment Plan Creation or Update in Past 90 Days\" )\n        or \"Had Opioid Treatment Plan Reviewed in Past 90 Days\"\n    )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "34" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 39;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Inclusion Criteria" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Inclusion Criteria\":\n  \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\"\n    and Routines.\"CDC 2022 Guideline General Inclusion Criteria\"\n    and Routines.\"Is Opioid Naive?\"\n    and \"No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "35" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 40;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSREC02" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Recommendation Applicable?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define \"Is Recommendation Applicable?\":\n  \"Inclusion Criteria\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "36" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 41;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Opioid Analgesic with Ambulatory Misuse Potential?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function \"Is Opioid Analgesic with Ambulatory Misuse Potential?\"(value List<MedicationRequest>):\n  (\"Get MedicationRequest Medication as Code\"(value)) Rx\n    where Rx.medication in \"Opioid analgesics with ambulatory misuse potential\" \n      and Rx.category in \"Community\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "37" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 42;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Get MedicationRequest Medication as Code" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function \"Get MedicationRequest Medication as Code\"(value List<MedicationRequest>):\n  value Rx\n    let Med: \n      if Rx.medication is Reference then singleton from (\n        [Medication] M\n          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))\n      ) else null\n    return \n      MedicationRequest {\n        id: Rx.id,\n        status: Rx.status,\n        intent: Rx.intent,\n        category: Rx.category,\n        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,\n        subject: Rx.subject,\n        authoredOn: Rx.authoredOn,\n        recorder: Rx.recorder,\n        dosageInstruction: Rx.dosageInstruction,\n        dispenseRequest: Rx.dispenseRequest\n      }" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "38" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 43;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToString" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToString(value string): value.value" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "39" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 44;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToConcept" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "40" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 45;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToCode" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "41" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 46;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Subacute or Chronic Pain Prescription?" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "// End of Active Cancer Treatment Routine\n\n/*\n**  Routine #4\n**  For Subacute or Chronic Pain Routine\n**\n**  Definition                  | Answer to Proceed   | Details                                        | Data (Terminology) Requirement\n**  -----------------------------------------------------------------------------------------------------------------------------------\n**  Order for opioid analgesic  | Yes                 | Order for opioid analgesics with ambulatory    | Opioid analgesics with\n**  with expected supply        |                     | misuse potential with a supply duration of >=  | ambulatory misuse potential\n**  duration >= 28 days         |                     | 28 days                                        |\n**                              |                     |                                                |\n**                              |                     | - Subacute definition = order for opioid       |\n**                              |                     |   analgesics with ambulatory misuse            |\n**                              |                     |   potential with a supply duration of one to   |\n**                              |                     |   two months.                                  |\n**                              |                     | - Chronic pain definition = order for opioid   |\n**                              |                     |   analgesics with ambulatory misuse            |\n**                              |                     |   potential with a supply duration of >= two   |\n**                              |                     |   months.                                      |\n**  -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine function \"Is Subacute or Chronic Pain Prescription?\"(prescription FHIR.MedicationRequest):\n  \"Is Subacute or Chronic Pain Using Expected Supply Duration\"(prescription)\n    or \"Is Subacute or Chronic Pain Using Validity Period\"(prescription)" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "42" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 47;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Subacute or Chronic Pain Using Expected Supply Duration" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function \"Is Subacute or Chronic Pain Using Expected Supply Duration\"(prescription FHIR.MedicationRequest):\n  (\n    prescription.dispenseRequest is not null\n      and prescription.dispenseRequest.expectedSupplyDuration is not null\n      and (\n        Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days \n      )\n  )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "43" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 48;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "GetDurationInDays" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function GetDurationInDays(value FHIR.Duration):\n  if value is null then null\n  else\n    case\n      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }\n      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }\n      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }\n      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }\n      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }\n      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }\n      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }\n      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }\n      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')\n      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)\nend" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "44" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 49;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSRoutines" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Is Subacute or Chronic Pain Using Validity Period" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function \"Is Subacute or Chronic Pain Using Validity Period\"(prescription FHIR.MedicationRequest):\n  (\n    prescription.dispenseRequest is not null\n      and prescription.dispenseRequest.validityPeriod is not null\n      and (\n        days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 \n      )\n  )" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "45" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 50;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToDateTime" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToDateTime(value dateTime): value.value" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "46" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 51;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "OpioidCDSCommon" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "Get Active Ambulatory Medication Requests" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function \"Get Active Ambulatory Medication Requests\" (value List<MedicationRequest>) returns List<MedicationRequest>:\n  value Rx\n    where Rx.status.value = 'active'\n      and Rx.category in \"Community\"" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "47" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 52;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToString" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToString(value MedicationDispenseStatus): value.value" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "48" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 53;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToString" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToString(value CarePlanStatus): value.value" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "49" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 54;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "libraryName" ];
       fhir:Extension.value [ fhir:value "FHIRHelpers" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "name" ];
       fhir:Extension.value [ fhir:value "ToDateTime" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "statement" ];
       fhir:Extension.value [ fhir:value "define function ToDateTime(value instant): value.value" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "displaySequence" ];
       fhir:Extension.value [ fhir:value "50" ]
     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" ]
  ], [
     fhir:index 55;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem" ];
     fhir:Extension.value [
       fhir:Reference.reference [ fhir:value "Device/cqf-tooling" ]
     ]
  ], [
     fhir:index 56;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" ];
     fhir:Extension.value [ fhir:value "#effective-data-requirements" ]
  ];
  fhir:PlanDefinition.url [ fhir:value "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-02"];
  fhir:PlanDefinition.identifier [
     fhir:index 0;
     fhir:Identifier.use [ fhir:value "official" ];
     fhir:Identifier.value [ fhir:value "cdc-opioid-guidance" ]
  ];
  fhir:PlanDefinition.version [ fhir:value "2022.1.0"];
  fhir:PlanDefinition.name [ fhir:value "PlanDefinition_Recommendation_02_Order_Sign"];
  fhir:PlanDefinition.title [ fhir:value "Recommendation #2 - Opioid Therapy Goals Discussion"];
  fhir:PlanDefinition.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/plan-definition-type" ];
       fhir:Coding.code [ fhir:value "eca-rule" ];
       fhir:Coding.display [ fhir:value "ECA Rule" ]
     ]
  ];
  fhir:PlanDefinition.status [ fhir:value "draft"];
  fhir:PlanDefinition.experimental [ fhir:value "true"];
  fhir:PlanDefinition.date [ fhir:value "2025-08-06"];
  fhir:PlanDefinition.publisher [ fhir:value "Centers for Disease Control and Prevention (CDC)"];
  fhir:PlanDefinition.contact [
     fhir:index 0;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "https://www.cdc.gov" ]
     ]
  ];
  fhir:PlanDefinition.description [ fhir:value "Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks."];
  fhir:PlanDefinition.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ];
       fhir:Coding.display [ fhir:value "Clinical Focus" ]
     ];
     fhir:UsageContext.value [
       a sct:182888003;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         a sct:182888003;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "182888003" ];
         fhir:Coding.display [ fhir:value "Medication requested (situation)" ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ];
       fhir:Coding.display [ fhir:value "Clinical Focus" ]
     ];
     fhir:UsageContext.value [
       a sct:82423001;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         a sct:82423001;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "82423001" ];
         fhir:Coding.display [ fhir:value "Chronic pain (finding)" ]
       ]
     ]
  ], [
     fhir:index 2;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ];
       fhir:Coding.display [ fhir:value "Clinical Focus" ]
     ];
     fhir:UsageContext.value [
       fhir:CodeableConcept.text [ fhir:value "Subacute pain" ]
     ]
  ];
  fhir:PlanDefinition.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [ fhir:index 0 ]
  ];
  fhir:PlanDefinition.purpose [ fhir:value "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care."];
  fhir:PlanDefinition.usage [ fhir:value "Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks."];
  fhir:PlanDefinition.copyright [ fhir:value "© CDC 2016+."];
  fhir:PlanDefinition.topic [
     fhir:index 0;
     fhir:CodeableConcept.text [ fhir:value "Opioid Prescribing" ]
  ];
  fhir:PlanDefinition.author [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "Kensaku Kawamoto, MD, PhD, MHS" ]
  ], [
     fhir:index 1;
     fhir:ContactDetail.name [ fhir:value "Bryn Rhodes" ]
  ], [
     fhir:index 2;
     fhir:ContactDetail.name [ fhir:value "Floyd Eisenberg, MD, MPH" ]
  ], [
     fhir:index 3;
     fhir:ContactDetail.name [ fhir:value "Robert McClure, MD, MPH" ]
  ];
  fhir:PlanDefinition.relatedArtifact [
     fhir:index 0;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.display [ fhir:value "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain" ];
     fhir:RelatedArtifact.url [ fhir:value "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm" ];
     fhir:RelatedArtifact.document [
       fhir:Attachment.url [ fhir:value "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm" ]
     ]
  ];
  fhir:PlanDefinition.library [
     fhir:value "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC02";
     fhir:index 0
  ];
  fhir:PlanDefinition.action [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
       fhir:Extension.value [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
           fhir:Coding.code [ fhir:value "strong" ];
           fhir:Coding.display [ fhir:value "Strong" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
       fhir:Extension.value [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
           fhir:Coding.code [ fhir:value "moderate" ];
           fhir:Coding.display [ fhir:value "Moderate quality" ]
         ]
       ]
     ];
     fhir:PlanDefinition.title [ fhir:value "Maximize Nonopioid Therapies as Appropriate" ];
     fhir:PlanDefinition.description [ fhir:value "For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate.\r\n\r\n[Recommendation 2 of the CDC 2022 Clinical Prescribing Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation2) provides nonopioid therapy recommendations for common subacute and acute pain conditions.\r\n\r\n**Nonopioid Pharmacological Therapy**\r\n- [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74))\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).)\r\n- [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).)\r\n- [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).)\r\n\r\n**Nonpharmacologic Treatments**\r\n- [Back pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20recommend%20appropriate%20noninvasive%20nonpharmacologic%20approaches%20to%20help%20manage%20chronic%20pain%2C%20such%20as%20exercise%20(e.g.%2C%20aerobic%2C%20aquatic%2C%20or%20resistance%20exercises)%20or%20exercise%20therapy%20(a%20prominent%20modality%20in%20physical%20therapy)%20for%20back%20pain)\r\n- [Back pain (low back, chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=loss%20for%20knee%20osteoarthritis%3B%20manual%20therapies%20for%20hip%20osteoarthritis%3B-,psychological%20therapy%2C%20spinal%20manipulation%2C%20low%2Dlevel%20laser%20therapy%2C%20massage%2C%20mindfulness%2Dbased%20stress%20reduction%2C%20yoga%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20low%20back%20pain,-%3B%20mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or)\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%2C%20and%20acupuncture%20for%20neck%20pain%3B%20cognitive-,behavioral%20therapy%2C%20myofascial%20release%20massage%2C%20mindfulness%20practices%2C%20tai%20chi%2C%20qigong%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20fibromyalgia,-%3B%20and%20spinal%20manipulation%20for%20tension%20headache%20()\r\n- [Headache (tension)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=and%20spinal%20manipulation%20for%20tension%20headache.)\r\n- [Knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Many%20noninvasive%20nonpharmacologic,for%20hip%20osteoarthritis%3B)\r\n- [Neck pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or%20qigong)%2C%20massage%2C%20and%20acupuncture%20for%20neck%20pain%3B)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%2C%20patient%20education%20and%20self%2Dcare%20can%20be%20effective%2C%20as%20can%20occlusal%20splints%20for%20some%20patients%20and%20biobehavioral%20therapy%20for%20prevention%20of%20disabling%20symptoms%20(172%2C173).)" ];
     fhir:PlanDefinition.priority [ fhir:value "urgent" ];
     fhir:PlanDefinition.trigger [
       fhir:index 0;
       fhir:TriggerDefinition.type [ fhir:value "named-event" ];
       fhir:TriggerDefinition.name [ fhir:value "order-sign" ]
     ];
     fhir:PlanDefinition.condition [
       fhir:index 0;
       fhir:PlanDefinition.kind [ fhir:value "applicability" ];
       fhir:PlanDefinition.expression [
         fhir:Expression.description [ fhir:value "Check whether the current order is for an opioid with ambulatory misuse potential, a pain treatment plan has been established or edited within the past 90 days, a pain management procedure occurred within the past 90 days, the patient is opioid naive and if the 2022 CDC guideline general inclusion criteria is met" ];
         fhir:Expression.language [ fhir:value "text/cql.identifier" ];
         fhir:Expression.expression [ fhir:value "Is Recommendation Applicable?" ]
       ]
     ];
     fhir:PlanDefinition.groupingBehavior [ fhir:value "visual-group" ];
     fhir:PlanDefinition.selectionBehavior [ fhir:value "any" ];
     fhir:PlanDefinition.action [
       fhir:index 0;
       fhir:PlanDefinition.description [ fhir:value "Document - Collaborated with patient to identify treatment goals" ]
     ], [
       fhir:index 1;
       fhir:PlanDefinition.description [ fhir:value "Snooze* - Attempting alternate therapy, snooze 3 months" ]
     ], [
       fhir:index 2;
       fhir:PlanDefinition.description [ fhir:value "Order - Select alternative therapies from order select" ]
     ], [
       fhir:index 3;
       fhir:PlanDefinition.description [ fhir:value "Snooze* - N/A see comment, snooze 3 months" ]
     ], [
       fhir:index 4;
       fhir:PlanDefinition.description [ fhir:value "Remove - Will remove triggering medication order" ]
     ]
  ] .

# -------------------------------------------------------------------------------------

